The Heart is an Organ of Fire

Why do we have two hearts? Medically speaking, there's the heart that pumps blood and oxygen around your body. Culturally, there's the heart as a symbol of love and emotion. Are these two different notions of the heart linked? In this historical, medical and emotional journey through the human heart, you'll meet a man whose heart stopped for ten minutes, the woman who loves him - and a medical historian.

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Transcript

Heartbeat/musicAmanda Smith: Today in The Best of The Body Sphere: the heart is an organ of fire. Hello, Amanda Smith with you on RN. Now have you ever wondered why we have two very different notions of the human heart? One is the symbol of love and emotion (and maybe you’ll give or receive a love heart next month for Valentine’s Day), but there’s also the medical heart, the muscle that pumps blood and oxygen around your body. That hasn’t always been the medical view of the heart though. Up until the 17th century and dating back to classical times it was different.Fay Bound Alberti: For Aristotle, the heart was the origin of life and the origin of emotions. So historically speaking, medical understandings of the body and of the mind put emotions in the heart. Which is why we have this very ambiguous relationship with the heart today: as an organ of both science and emotion.Amanda Smith: That’s the medical historian Fay Bound Alberti and more from her later here in The Body Sphere. I want you to meet now though a couple whose hearts have been severely tested, medically and emotionally. Matt Parkinson is a comedian, actor and broadcaster and his heart stopped for 10 minutes. MaryAnne Carroll is his wife and it happened on her birthday.MaryAnne Carroll: It was beautiful sunny day and I’d decided to stay home from work so we could spend it together. And we had a beautiful day with the back door open and the dogs going in and out and we were both pottering around and spending a lovely afternoon together. And he cooked me my favourite dinner and we had a beautiful, beautiful meal together. And he plays indoor cricket on a Monday night and so he was debating whether to go or not, because it was my birthday. I said to him absolutely go and play, we’ve had a great day together and meal together. So he went off to cricket. And that was the last a saw or heard of him, until the call came.MusicMatt Parkinson: With a bunch of friends I’ve known for a couple of decades we’ve been playing in this team – indoor cricket. It’s a bit of a casual knock around and so on. And I have to point out that I’m going on second-hand information because I don’t remember what happened on the night. Apparently at one point there was a delay in play, the electronic scoreboard (which is really just a computer hooked up to a big screen TV), that stopped working and my team mates tell me they watched me lie down on the ground.Amanda Smith: Because you were batting.Matt Parkinson: I was batting. I was on strike, so I was probably a bit excited, but they then saw me lie down on the ground and they thought that I was having a bit of a joke round because there was a break in play, they thought I was pretending to have a bit of a nap or whatever. And then the chap who was umpiring (because the umpire sits up behind the batsman on a chair, high up on the wall), he said look, I think something’s wrong. And then a couple of my mates came in through the opening in the netting that surrounds the pitch and they were sort of literally poking me with their fingers going come on Parko, it’s not funny anymore. And then they went oh hang on, no he’s not right. So luckily enough the chap umpiring the game was a recently retired service man, so he had up to date CPR training because of his service experience, and there was somebody from a game going on next door on the other side of the net (there’s normally two games at the same time), somebody came in from that game and those two blokes were doing chest compressions on me, while one of my team mates John Thompson was giving me mouth to mouth – old school. And I pretty much owe my life to them, and to the paramedics who arrived within 10 minutes I’m told.MusicMaryAnne Carroll: I’d just gone to bed and our phone rang and it was one of his team mates, who initially called and left a very short message and then hung up. And I didn’t have their number to call them back. While I was looking for his number, he called back again. He said that Mat had had a seizure, and as he was saying that I could hear yelling in the background and he said hang on, hang on - and then he said the ambos are telling me to tell you that he’s had a heart attack.My father died of a heart attack when I was 16 so to hear those words was like having a hot steel rod pierce right through my heart. HeartbeatAmanda Smith: You get to the hospital and then what happens?MaryAnne Carroll: So the doctors came out to see me and told me that they thought it was his brain because he hadn’t presented like somebody who had had a heart attack. And so they were going to do a scan to determine whether there was a major brain bleed. And basically if that was the case that it would be a kind of final scenario. So after they did that and after some time, I can’t remember how long it took, but then they came back and said they couldn’t find any trace of a major bleed in the brain so therefore they thought it was the heart. And that there was no space at that hospital so they were transferring him to another hospital.HeartbeatSo I went in the ambulance with him, and at that hospital that’s when they started to put him into the coma. And that they wouldn’t know anything for 48 hours, and that as they would bring him out of the coma that’s when they would be able to determine from then on the stage… They told me that there would be brain damage but they wouldn’t know how much brain damage until time after he came out of the coma.Heart monitorMatt Parkinson: There’s a new procedure for resuscitating people who have suffered cardiac arrest which involves inducing mild hypothermia. You are basically packed in ice to stop your body tissues from spoiling. It’s like putting you in the fridge until your full function can be restored, until your heart can be relied on to keep the blood flow going.Amanda Smith: So you’re literally put on ice?Matt Parkinson: Yes, that’s exactly right. And I do have - for the two and a half to three days that I was in that induced coma - I do have a memory of a very long, inescapable dream and the first part of that I remember being very cold. I remember for hours and hours, dreaming this long interminable dream that I was swimming in Bass Strait in darkness and it was very, very cold (needless to say because it was Bass Strait in the middle of darkness). One of the things that was distinctive in my dream was I remember thinking, I’m much colder on my back, which was just getting splashed by water, than I am on my front. I’m actually quite warm on my front (and I was swimming face down) and I realised that was because I was lying on top of the ice bed, with a little bit of ice on top of me. So of course my back was feeling the cold much more than the front of me which felt comparatively warm.Amanda Smith: Well Matt’s heart stopped literally but yours must have also metaphorically – I mean what was the physical as well as the emotional sensation for you of having this happen to the person you love?MaryAnne Carroll: It felt like a parallel experience of reliving what happened with my father, and dealing with it happening with my husband. But I also felt a very strong survival instinct, and if I allowed myself to think about what might happen, that I would just combust. I just didn’t feel I could actually deal with the thought of him dying. So I just didn’t allow myself to go there at all, even though I was being prepared for the worst case scenario all along by the medical team. I decided just to stay in the moment and while he was breathing and while his heart was pumping, even though he had assistance, that I would just keep really calm and focus on each breath that he was taking. But I could feel my heart pump and hear my heart pump. There were times when I was in ICU with him or any time, especially at night with him beside his bed, it was like I could hear my heart in my head – it was incredible, yeah.Heartbeat/musicAmanda Smith: MaryAnne Carroll and Matt Parkinson will be back to continue the story of their hearts a little later here in The Body Sphere. Fay Bound Alberti is the author of Matters of the Heart; this is a book where she braces the history of the human heart: emotional and medical. Fay the popular, not the medical but the popular association of the heart with emotion and as a symbol of love – now where does that come from?Fay Bound Alberti: It comes from most ancient of times; it’s very difficult to locate one particular source because all cultures across time seem to associate emotions with the heart. In the most basic sense I think it’s because we associate feeling with the heart, we feel emotions in the heart, our heart beat races when we see someone we love. For Aristotle the heart was the origin of life and the origin of emotions, so historically speaking, medical understandings of the body and of the mind put emotions in the heart. Which is why we have this very ambiguous relationship with the heart today as an organ of both science and an organ of emotion.Amanda Smith: And it’s really the Roman physician of the 2ndcentury - Galen - who systematises this in a way that endures through medical science for centuries. Fay Bound Alberti: Yes Galen developed Hippocrates’ ideas in a way that remained central to medical practice for nearly 2000 years. And what he did was to divide the human body experiences into four particular humours. They were: blood which was hot and moist like air, choler which was hot and dry like fire, phlegm which was cold and moist like water and black bile which was cold and dry like earth. And the understanding was that we all have a different ratio of these particular humours in our body. And the idea for Galen was very much that these humours, that were generated and revolved around the heart, affected our emotional states in very graphic ways. So we became hot tempered, or hot blooded, or cold hearted - and those understandings, those linguistic understandings of what we’re feeling, remain very much part of our emotional lexicon today.Amanda Smith: Do you know though where the heart symbol, the two curves running down to a tip - you know the red love heart on all those Valentine cards that I’m going to get - do you know where that comes from?Fay Bound Alberti: Nobody knows where it comes from. The most interesting thing is that the symbol of the love heart has absolutely no relationship to the physical heart you find in the chest. It’s from about the 14th century that we see this very pretty symbol that we have today on Valentine’s Day. People say that perhaps it represents the two halves of a united couple. The say that maybe it represents a seed, a particular seed that people have used historically as an aphrodisiac and so on.Amanda Smith: This is the silphium plant.Fay Bound Alberti: That’s right, but there’s no real definitive understanding of where it comes from. What’s really fascinating is just how prevalent and just how enduring it is as a symbol; and a lot prettier symbol than the actual lump of muscle in the chest.Amanda Smith: Well as we said Galen’s theory of the way the body works, with the heart as the seat of emotion, endures until the 1600s - remarkable - but what happens then?Fay Bound Alberti: Well I would argue probably that Galen’s interpretation of the body in medical practice remains in place until the 19th century; even after William Harvey described, form 1628, the circulation of the blood. Now with Harvey’s understanding of the blood moving around the body, traditional ideas about the humours, as being static entities that move around the body, becomes impossible to sustain. His idea is that with the circulation of the blood, you have a removal of emotions from the body and they become mental experiences. But in reality, despite the fact that people believed in the circulation of the blood, medical practice still involved things like bloodletting - if you were too hot tempered maybe you needed to remove them of that blood.So there was a real disjunction between what people thought and what people did.Amanda Smith: And does Descartes and his cogito ergo sum have anything to do with changing notions of the human heart?Fay Bound Alberti: What’s fascinating I think about the nature of the human heart and its links to emotion is that, in the west in particular, we have this idea dating back from Descartes that there is a split between mind and body. And that split came about because Descartes argued emotions were physical experiences that happened in the body that the mind translated and understood. But our mind itself is a very rational space that’s associated with the soul moving through the pineal gland located in the brain. Now what this means in practice is that there’s a split between: the mind is associated with emotions for the first time and the body that’s associated with mechanistic processes. And those mechanistic processes were taken from the work of Harvey who described the circulation of the blood in mechanistic terms.Amanda Smith: And the heart is part of the body?Fay Bound Alberti: That’s right, so the heart is part of the body.MusicAmanda Smith: You’re listening to The Body Sphere on RN where we’re delving into the human heart, I’m Amanda Smith with medical historian Fay Bound Alberti joining us from London. So Fay really I guess what you’re describing, and as you describe in your book, a scientific transition from a cardio centric view of the human body to a cranio centric one.Fay Bound Alberti: That came into being really with the rise of scientific medicine in the 19th century and the rise of the mind sciences, which means the development of psychology, of psychiatry, of believing that our emotions are part of our brains and our mental selves.Amanda Smith: One would expect then that the kind of scientific, rational, mechanistic heart would increasingly take over from the emotional heart (be still not my beating heart but my pumping heart!); and for this to happen not only within the field of medicine but more generally in the culture. Does it though?Fay Bound Alberti: It does in terms of scientific writings, but with many things that have a particular set of ideas attached to them, there’s a backlash. So we have the rise of Romanticism for instance in the 19th century and the development of Romantic poets, romantic love, the desire to pursue heart’s destinies. So this is a backlash against scientific rationalism against the Industrial Revolution. And the emergence of concepts like Valentine’s Day, where we exchange tokens of our love, becomes in some way I suppose the desire for individual pursuit of truth, for destiny, for all of these concepts that have been part of cultural consciousness. And interestingly again what’s happened post-20th century is the rise of medical science trying to explain why we feel in the heart, why transplant patients have memories of their donor’s experiences. And so there is this rise of the idea of the brain living in the heart, of cellular memory. So science is increasingly trying to explain why it is that we still feel in the heart and we still hang on to this idea of the heart as an emotional organ.Amanda Smith: Well there’s also of course a whole religious history of the heart: in Christianity the sacred heart of Jesus; and then the day for lovers being St Valentine’s. Although I don’t think anyone’s sure precisely why or which particular Christian martyr called Valentine the day is named for . But I’m fascinated in your suggestion that now we are trying to find a way to reconcile the heart of science with the heart of emotion. Fay Bound Alberti: Some of the most interesting, what we call alternative medical practices, whether it’s the Ayurvedic tradition, or the Chinese medicine tradition, are able to understand the heart in holistic terms. So that physical experiences in the body are part of mental experiences, and there isn’t the very rigid divide that we find in western practice. And my sense is that approach in understanding our bodies and ourselves and our hearts and our heads as being entwined in some way is a much healthier way of understanding our experiences in the present day.Amanda Smith: And it really brings together those two quite divergent notions of the rational and scientific and mechanistic heart with the intuitive and passionate ‘heartfelt’ heart.Fay Bound Alberti: Yes it does absolutely. In some ways it takes us back to Galen, and the idea that we all have different personalities that are a product of what we would call our hormones, but what Galen called humours. And we are all prone to certain ways of behaving and feeling depending on our personality types And I think we’re getting back in some ways to Galenic interpretations of the body, but with a modern scientific spin.Amanda Smith: Fay Bound Alberti is the author of Matters of the Heart – History, Medicine and Emotion.Well let’s come back now in The Body Sphere to Matt Parkinson, the man who’s had a cardiac arrest playing cricket and at hospital is put into a coma, and by his bedside his wife MaryAnne.Heart monitorMaryAnne Carroll: On the night of the first coma day, I allowed myself for about half an hour to go to a really dark place. And in that dark place I touched on the worst thing that could happen, not if he died but if he was you know in whatever state he would be afterwards for not having oxygen etc. And I said to myself, I married this man seriously for better or worse and I’m completely unconditionally sticking to those vows and to that belief. And so regardless of what state he’s in afterwards I am going to look after him and stay with him till death do us part. So all I’ve got to do is not let him die. I don’t care what state he comes back, how broken he is, or whatever state his brain is in, or his body is in, I’m going to stay married to him for the rest of our life.MusicHaving done that, then the next day and then the days that followed after that, I felt incredibly powerful because I felt our love was really, really, really powerful. And I know this might sound a bit arrogant or a bit overconfident but I felt if I did stay focussed I could really pull him back. So I touched him continually and spoke to him continually, when he was unconscious, to just pull him back. I know he had a lot to do with that and the medical staff but it’s the feeling that I had at the time, was that if I just took care of making him want to come back, as opposed to physically being made to come back, that that would somehow contribute given that I had absolutely no medical knowledge or experience. I was not in any way able to assist in that side of things.Amanda Smith: Well the extraordinary thing is that despite having been dead for 10 minutes - a heart that had stopped beating for 10 minutes - and all the possibilities that could have and were likely to have come about from that he emerged from that coma, fine.MaryAnne Carroll: Eventually. Yeah. When he was finally able to focus on me and know that it was me he would ask me what happened. And I would tell him that (even though it was a cardiac arrest I was using the word heart attack), I would say, you had a heart attack three days ago but you’re in the hospital now and you’re really well looked after and everything is alright. And he would be so shocked at receiving that news, like it would be such a jolt. And he would sort of lie back and close his eyes for a minute, and then he would open his eyes and say where am I, what happened, and I’d have to tell him again. And seriously I think that was 180 times a day that that would happen just over, and over.Amanda Smith: How did you cope with his distress, over and over about that?MaryAnne Carroll: That where just staying in the moment and staying focussed was so crucial, because I think if I’d freaked out or if I’d acted like I wanted to act, which was to scream or cry or to give into the panic or the fear - the fear of the unknown or the panic of past experience and past loss or whatever - that would have been worse for him. But it was really painful to have to keep telling him over and over and over. Basically it was like I was stabbing him every time I told him as well; but I spoke to a doctor about it and they said no, it’s important just to be honest and to keep answering him every time he asks.But we also had, like a couple of days later, we’d have amazing, fantastic, incredible conversations. Which he completely doesn’t remember.Music/ heart monitorAmanda Smith: So what happened with Matt?Matt Parkinson: An electrical fault. It’s still a bit of a mystery to my cardiologist ,but we think we might be getting a bit of a lead on what caused the cardiac arrest in the first place.Amanda Smith: What’s the lead?Matt Parkinson: You have in the middle of your heart you have a node which delays the electrical pulse - and I apologise if I’m getting this wrong this was how my cardiologist was best able to explain it. It delays the electrical impulse so in each bed of your heart you have a top/bottom, top/bottom, and that’s what keeps the blood flowing around to your lungs and then around your body. And what happened in my case is that the top and the bottom started beating very fast and at the same time. Your heart is then like a lump of jelly in a bowl, just quivering It’s not pumping any blood around your body at all and it can only keep that up for so long because it’s beating in excess of 200 a minute at that stage.Now the reason we know this is I have an implant - a combination pacemaker and defibrillator implanted in my chest now. And when I go in for a check-up they have a little blue tooth connection that goes over that and it prints out a history that tells them exactly what my heart has been doing. So on this most recent check-up, because my cardiologist had said go back and play indoor cricket again, I’ve been back - and lo and behold on those nights when my heart rate was up, my heart was getting very close to doing what it did on the night of the attack.Amanda Smith: This must make you surely cautious about running around about playing cricket.Matt Parkinson: At an intellectual level it does, but then at a very primal level I just felt so energised by having a new lease of life. I mean fundamentally I was dead for ten minutes and I came back to life and I felt so energised by that; but also by the fact that I’ve got this implant inside me now - so if anything - in a way I’m better equipped now for anything bad happening than I ever was for the first 47 years of my life, when I was running around with this unknown fault inside me and no pacemaker and no defibrillator. Well, I have a pacemaker and defibrillator in me now, so, at the risk of pushing my luck, I’ll say touch wood that I don’t have to worry, because this thing will do the job for me.Amanda Smith: The other thing is - you said that you were dead for ten minutes - I mean it’s amazing you don’t have brain damage.Matt Parkinson: Yes, that’s another thing for me to be grateful for.Amanda Smith: And also I think the ambulance officers who took you to hospital -picked you up from the cricket venue and took you to hospital - actually visited you, later.Matt Parkinson: I did have one of them, Jarrod, came back to visit me later in the week. And I gather paramedics are in the habit of looking up people, just to follow up on them and see how they’ve gone, because it must be very rewarding to see somebody who you last saw on the brink of death. And I gave him a big hug and I gave his partner a big hug. And she said, I actually wasn’t there on the night, and I said I don’t care you’re an ambo you’re getting a hug anyway. And Jarrod and I just sat there and chatted.And he looked at me like I was Christmas, Amanda, which was a great feeling for him and for me.Amanda Smith: Because he didn’t think you were going to make it.Matt Parkinson: He did not think that I was going to make it – no. And I’ve since learned that in their own grim sense of humour, paramedics (I don’t know whether I’m giving away a professional secret here), but paramedics have a way of making sure that they have the appropriate rhythm for the chest compressions when they’re looking after people. And there’s two songs they can choose from to keep their compressions in rhythm. And one is, when they think the outlook is good they go: Ah, ah, ah, staying alive, staying alive… Music …but they also do it to the tune of Another One Bites the Dust, if they’re… MusicAmanda Smith: And this is the one the paramedics used for Matt. Well Matt having survived an episode where your body completely failed you, just stopped working, how has it changed you?Matt Parkinson: It’s made me much more aware of everything about my body, I think. For a long time - I have a lean build - so I’ve always been able to eat whatever I wanted. My good cholesterol was in the proper range; my bad cholesterol was in the proper range, everything was right. So for decades I’ve been able to just take my health for granted pretty much. So for the first time in my life now because of this, I am actually connected to my body. It makes me think about what goes on in my body. And also having, as you say, it completely fail on you, when I get out of bed in the morning I’m just like, this is great, I can get up, move around a walk, I am alive - because for a little while I wasn’t.MaryAnne Carroll: I’ve always thought instincts were really important, and to trust your instincts was really, really crucial. But I’d always sort of associated instincts with coming from your gut. Like trust your gut, trust the instincts in your gut. And I think what I really learnt from this experience was that the feeling of power and the feeling of knowing what to do and the ability to stay in the moment and keep it together and stay strong and stay focussed, and deal with everything else that was happening with friends and family (you know, there were a lot of people needing a lot of things at that time) - but that came from my heart, not from my gut. So it was like mind and heart being connected, helped me to do what I needed to do, to get me through it. Especially nursing him after he came home, which was a whole different range of issues for both of us to deal with, but in that time it was definitely our hearts – our hearts together that got us through that period, definitely. Definitely.MusicAmanda Smith: The heart is an organ of fire – that’s a line from the novel by Michael Oondatje, The English Patient. I’m Amanda Smith and in The Body Sphere today you heard from MaryAnne Carroll and her husband Matt Parkinson. Also, the medical historian Fay Bound Alberti. Her book is Matters of the Heart – History, Medicine and Emotion. It’s published by Oxford University Press, and details are on The Body Sphere website - where you can also leave a comment - or an early Valentine!

Guests

Dr Fay Bound Alberti

Medical historian and author of 'Matters of the Heart: History, Medicine and Emotion'

Matt Parkinson

Comedian, broadcaster. Suffered a cardiac arrest while playing indoor cricket; his heart stopped for ten minutes. He survived.